Healthcare Provider Details

I. General information

NPI: 1619993888
Provider Name (Legal Business Name): CATHLEEN E KESSLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 DIXIE ST
CARROLLTON GA
30117-3818
US

IV. Provider business mailing address

119 AMBULANCE DR SUITE 202
CARROLLTON GA
30117-3857
US

V. Phone/Fax

Practice location:
  • Phone: 770-838-8824
  • Fax: 770-838-8563
Mailing address:
  • Phone: 770-838-8824
  • Fax: 770-838-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704210207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: